Splenic irradiation for splenomegaly: A systematic review

Abstract

Splenic irradiation (SI) is a palliative treatment option for symptomatic splenomegaly (i.e. for pain, early satiety, pancytopenia from sequestration) secondary to hematologic malignancies and disorders. The purpose of the current article is to review the literature on SI for hematologic malignancies and disorders, including: (1) patient selection and optimal technique; (2) efficacy of SI; and (3) toxicities of SI. PICOS/PRISMA methods are used to select 27 articles including 766 courses of SI for 486 patients from 1960 to 2016. The most common cancers treated included chronic lymphocytic leukemia and myeloproliferative disorders; the most common regimen was 10Gy in 1Gy fractions over two weeks, and 27% of patients received retreatment. A partial or complete response (for symptoms, lab abnormalities) was obtained in 85-90% of treated patients, and 30% were retreated within 6-12months. There was no correlation between biologically equivalent dose of radiation therapy and response duration, pain relief, spleen reduction, or cytopenia improvement (r all <0.4); therefore, lower doses (e.g. 5Gy in 5 fractions) may be as effective as higher doses. Grade 3-4 toxicity (typically leukopenia, infection) was noted in 22% of courses, with grade 5 toxicity in 0.7% of courses. All grade 5 toxicities were due to either thrombocytopenia with hemorrhage or leukopenia with sepsis (or a combination of both); they were sequelae of cancer and not directly caused by SI. In summary, SI is generally a safe and efficacious method for treating patients with symptomatic splenomegaly.

The role of bone marrow and spleen irradiation in the development of acute hematologic toxicity during chemoradiation for esophageal cancer

“…Radiation therapy has been used for many decades in the palliative setting for symptomatic splenomegaly, including for cytopenias in the setting of myeloproliferative disorders. 10 In contrast, no patients in our cohort demonstrated a pathologically enlarged spleen or known history of myeloproliferative disorder. Our data suggest that irradiation of the normal spleen may have physiologic effects similar to those of irradiation for symptomatic splenomegaly and may limit cytopenias associated with other etiologies.…”

Body Weight and Platelet Count Changes in Zidovudine Administered Wistar Albino Rats Treated with Ethanolic Extracts of Annona muricata and Fagara zanthoxyloide

“…Splenic atrophy also observed in the negative control group may be the result of prolonged administration of drugs which occurs usually secondary to body weight loss [32]. Despite the increase spleen weights observed from the result of organ weight changes in extract treatment group, the histology results showed no case of pathological splenomegaly and as such would rule out the possibility of platelet sequestration as is the case with thrombocytopenia caused by hepatic cirrhosis or congestive splenomegaly [33,34].…”

Identification of a Splenic Marginal Zone Lymphoma Signature: Preliminary Findings With Diagnostic Potential

“…SMZL presents extremely heterogeneously and, as a result, a myriad of differential diagnostic assessments are utilized in an attempt to accurately identify the malignancy (13,14). Due to inconsistencies among most evaluations, the definitive diagnosis of SMZL is typically only recognized upon review of spleen histology following a splenectomy (13); an operation that should be exercised as an absolute last resort due to the impending associated health risks (15,16). What's more, even among cases properly diagnosed with SMZL, accurate genomic prognoses are not currently possible.…”